Intermittent symptoms in neurocysticercosis: could they be epileptic?

Some patients with neurocysticercosis (NCC) develop perilesional gliosis during the course of healing and carry poor prognosis for the seizure control. We evaluated the clinical status of these patients during complete control of their original seizures on anti-epileptic drugs (AED).

We studied 172 patients with solitary NCC, 45 with perilesional gliosis as visible on magnetization transfer spin echo (MTSE) magnetic resonance imaging and 127 without gliosis, for any abnormal symptom during the course of their "seizure-free" period. All of them received optimum doses of AED to control the original seizures.

Patients with gliosis had high incidence of abnormal symptoms with or without corresponding abnormalities on surface electroencephalogram (EEG). These symptoms disappeared on increasing the dose or adding a new AED. The symptoms, which were transient episodic in nature, included heaviness, dystonic posturing, weightlessness, numbness and alien limb phenomenon on the side of the body contralateral to cerebral lesion, and headache.

Patients with NCC who develop perilesional gliosis during the process of healing tend to suffer from disturbing intermittent symptoms during their apparent control of seizures. The symptoms are controllable with increased dosage of previously prescribed or addition of another AED. As these symptoms could possibly be epileptic in nature, their identification and treatment may have a bearing on long-term seizure control after stopping AED therapy.